| NPI | 1396749651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV003916) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV003916) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY TUV003916) | |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2010-12-07 |